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General NPI Number Information
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NPI Number | 1225586498
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Entity Type | Organization
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Legal Business Name | BRITTINGHAM DENTISTRY, LLC
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 3742 WALTON WAY EXT
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City | AUGUSTA
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State | GA
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Zip | 30907-2417
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Country | US
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Telephone | 706-860-4190
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Fax | 706-650-8855
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Provider Business Mailing Address
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Address Line | 3742 WALTON WAY EXT
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City | AUGUSTA
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State | GA
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Zip | 30907-2417
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Country | US
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Telephone | 706-860-4190
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Fax | 706-650-8855
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Authorized Official
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Title or Position | VP/DENTIST
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Name | DR. MICHAEL ANDREW BRITTINGHAM
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Credential | D.M.D.
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Telephone | 706-860-4190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9859
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN014829
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License Number State | GA
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